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Poverty, bad habits and tradition are fuelling the spread of Ebola

Nobody would have thought that Gueckedou, a market town in southern Guinea, was the front line in West Africa’s battle against the deadly Ebola virus.

When I arrived to report on the outbreak, it was business as usual on the dusty, potholed streets. Traders set up their stalls under tattered, sun-bleached parasols and waved hand-held fans to stop the food spoiling in the tropical heat.

Below the surface, though, lay a simmering tension. Nobody shook hands here if they knew what was good for them, and those who could afford it bought gloves and face masks to avoid the gruesome disease that has killed well over 100 people in Guinea and Liberia since it was first reported in February.

Ebola has broken out periodically in Africa since it first appeared in 1976 in what were then Zaire and Sudan. The virus is spread through contact with infected blood, bodily fluids and tissue, often during funerals when the body is washed by close family members, or in hospitals where victims infect doctors and nurses who are not taking the right precautions.

In Gueckedou, health workers are fighting what the medical charity Medecins Sans Frontieres (MSF) described as an “unprecedented epidemic” with soap and education. Those already infected are isolated and nurses help to ease their suffering before their almost certain death. There is no cure and this strain, Ebola Zaire, kills up to 90 percent of victims.

Sweating profusely in head-to-foot plastic suits, overburdened and under-resourced, the MSF staff work under immense pressure to feed, clean and care for the patients despite the risk of infection and the reaction of local people, some of whom have accused them of bringing Ebola to Guinea.

SECONDARY OUTBREAK

Some 600 km (375 miles) from the epicentre of the outbreak, the tension is far more tangible in the capital Conakry, where 2 million people live at close quarters in often insanitary conditions. Here, citizens are worried that their government seems to be keeping them in the dark and fear a nationwide epidemic and an international lockdown.

In April, the authorities said that the number of new Ebola cases had fallen dramatically and the outbreak was almost under control. Days later 27 new cases were reported, prompting the French embassy in Conakry to send out a diplomatic circular warning of a secondary epidemic. Ebola is far from under control, and the blame for this is widely spread.

Guinea is one of the world’s 10 poorest countries, according to the World Bank. The average age of death is 56, only 19 percent of the population have access to modern sanitation, and the country has the lowest number of hospital beds per capita in the world. Disease surveillance and control measures are non-existent.

Poverty, bad habits and tradition are fuelling the spread of Ebola. Butchers sell bush meat in the markets despite a government ban; doctors who may be infected with Ebola refuse to go into quarantine and risk spreading the disease, and traditional funerals continue despite the health warnings about the cultural practices associated with them.

Finally, two major health organisations are splitting hairs over terminology, partly as a result of their different funding mechanisms, but also because of a deeper rift between public and private health providers. The World Health Organisation (WHO) has called the presence of Ebola in Guinea a “small outbreak,” while MSF calls it an “unprecedented epidemic”. The apparent disunity between the two undermines the impact of the response.

EBOLA HERE TO STAY

Scientists have confirmed that the Ebola virus in Guinea, though 97 percent identical to the Zaire strain, is in fact a novel strain that may have evolved in Guinea at the same time. The implications are that Ebola may strike again elsewhere in West Africa. If it does, how can we learn from the Guinean experience and improve the response to the next outbreak?

Guinea can be forgiven for its slow response. It was the first time that Ebola had hit the impoverished nation and the symptoms could easily be confused with those of minor infections like influenza, or of diseases endemic in the area like malaria or Lassa fever.

Still, given the release of donor funds after last year’s elections and the high level of foreign investment in its mineral riches, Guinea could have done more, and faster. A reduction in corruption and higher taxes on mining corporations could have released cash to build a better health system that could react quickly and effectively to a threatened epidemic.

On a global scale, public relation campaigns aimed at raising funds need to be wary of overstating the severity of an emergency. Even MSF staff questioned the description of the outbreak as an “unprecedented epidemic”. Understatements can be equally damaging. The WHO has tended towards agreement with MSF’s standpoint as the disease has spread. A united front would give more confidence to the public.

Better communication and more transparency would have helped win the public’s trust and encourage citizens to act together to overcome the disease. As one doctor told me, to fight Ebola you need knowledge, to fight panic you need the confidence of the population.

Finally, international journalists may have overplayed the impact of an Ebola outbreak in West Africa on countries in Europe and North America, given their good disease surveillance and medical practice. Local media did little to inform readers about personal hygiene in preventing the spread of Ebola, choosing instead to print a dubious April Fool’s Day joke about a possible cure.

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